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Internal Medicine > General Medicine > Flashcards

General Medicine Flashcards

1
Q

AAA screening

A

One time abdominal ultrasound for AAA in men between 65-75 in anybody who has ever smoked (100 cigarettes)

Decreases risk of death by 14% over 10 years

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2
Q

Lung cancer screening

A

Annual low dose CT in patients 55-80 with 30-pack-year history, who currently smoke of quit within 15 years

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3
Q

Pneumococcal vaccine

A

PPSV23 rec for all adults >65yrs of with other risk factors (asthma, DM, cirrhosis, asplenia). Dual vaccination provides best risk reduction.

PVC13 first, PSSV23 6-12 months later

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4
Q

Colonoscopy screening

A

If average risk, colonoscopy every 10 years starting at age 50
OR
Flex sig and fecal occult blood testing every 5 years

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5
Q

Zoster vaccine

A

Recommended for imunocompetent adults >60YO, regardless of history of chickenpox, shingles, or prior vaccination

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6
Q

STD screening (Chlamydia/Gon, HIV, and HPV)

A

Chlamydia: women under 25YO, men or women with high risk practices
HIV: all persons b/w 13 and 64 yrs
HPV: all women 9-26YO, men 11-21YO

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7
Q

Blood pressure targets

A

If 60YO: less than 150mmhg systolic

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8
Q

Which four groups of people should be on a statin?

A
  1. Known atherosclerotic disease
  2. 10-year risk of developing atherosclerotic disease >7.5%
  3. LDL>190
  4. Diabetes

Tx with high intensity atorvastatin (40mg or 80mg) or rosuvastatin (20mg or 40mg) if

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9
Q

What antidepressants are associated with weight loss?

A

Buproprion - contraindicated in patients taking MAO-i inhibitors or with seizures, eating disorders, psychiatric illness
Topiramate

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10
Q

When is it indicated to get bariatric surgery?

A

BMI >40

or BMI 35-40 with DM, OSA, or joint disease

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11
Q

What is the treatment for cocaine-induced chest pain?

A

Calcium channel blockers and benzodiazepines

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12
Q

What is the management algorithm for influenza A?

A

Early antiviral treatment, within 2 days of symptom onset, in hospitalized pts; severe illness; risk factors incl CV dz, CKD, cancer, liver disease, immunosuppression

Oseltamivir or zanamivir- influenza A, B, or unknown

Amantadine and rimantadine - Influenza A only. Widespread resistance, not recommended for community circulating strains.

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13
Q

What are the Wells Criteria for PE?

A

3 - signs and symptoms of DVT
3 - PE most likely
1.5 - HR >100
1.5 - 3 days immobilization or surgery in past 4 weeks
1.5 - previous PE or DVT
1 - hemoptysis
1 - malignancy, palliative or treated in last 6 months

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14
Q

Mallory-Weiss Tear vs Boerhaave syndrome

A

MW: Upper GI mucosal tear, caused by forceful retching, may have submucosal bleeding. Dx by EGD.

Boerhaave: esophageal transmural tear, caused by forceful retching, with esophageal air or fluid leakage into pleura. CT wiht gastrografin confirm dx. Amylase in pleural fluid.

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15
Q

Hereditory spherocytosis

A

Autosomal dominant
Lack of spectrin

Tx with oral folate, blood transfusions, splenectomy if refractory

If splenectomy, vaccinate with pneumococcal, hemophilus, and meningococcus, and daily penicillin prophylaxis for 3-5 years, as risk of sepsis present for 30 years

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16
Q

Pseudogout

A

Acute calcium pyrophosphate crystal arthritis
Most common in knee
Inflammatory (15K-30K cells), with CPPD crystals (rhomboid, positive birefringent)
Chondrocalcinosis or chronic calcification on imaging

Tx glucocorticoid injections, NSAID, colchicine

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17
Q

Gout

A

uric acid arthritis
Inflammatory (<50K), crystal (needle-shaped, negatively birefringent), in ankle or toe.

Tx NSAID, colchicine, corticosteoids

Chronic prophylaxis if >2 attacks per year or presence of tophus: with allopurinol (xanthine oxidase inhibitor), febuxostat (XO inhibitor), or probenecid (uricosuric, use in underextreters, risk of stones), decrease intake of meat, alcohol, seafood, avoid diuretics

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18
Q

What therapies can be used for BPH?

A

Alpha1 blockers: doxazosin, tamsulosin

5-alpha reductase inhibitors: finasteride

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19
Q

Babesiosis

A

Babesia microti, of Ixodes tick
Sc anemia, thrombocytopenia, flu-like sx

Labs show intravascular hemolysis (indirect high bilirubin, high LFT, high LDH, reticulocytosis)

Blood smear shows intracrythrocytic rings (Maltese cross)

Tx 7-10 days atovaquone + azithromycin OR quinine + clindamycin

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20
Q

Rocky Mountain spotted fever

A

Fever, HA, myalgia, rash that spreads centripetally and includes palms and soles

Most prevalent rickettsial illness in the US

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21
Q

Who is treated for hepatitis B?

A

Acute liver failure, cirrhosis, high serum HBV DNA, positive HBeAg and elevated ALT, or to prevent reactivation during chemotherapy/immunosuppression

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22
Q

What are treatments for HBV?

A

Interferon – short term, use in younger compensated patients, not in decompensated cirrhosis

Lamivudine – use in HIV patients

Entecavir – use in decompensated cirrhosis

Tenofovir – potent, low resistance, 1st line tx

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23
Q

What is the treatemtn for HCV?

A

Pegylated interferon plus ribavirin, +/- telaprevir for genotype 1

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24
Q

Statins

A

HMG-CoA reductase inhibitor: reduce conversion of HMG CoA to mevalonic acid, and increase number of LDL receptors

myalgias in 2-10% of patients (symmetrical, proximal) via decreased coqnzyme Q10 synthesis

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25
Q

G6PD deficiency

A

molysis after infection or medication (sulfa drugs, antimalarial, nitrofurantoin, TMP-SMX)

Lab +Prussian blue stain for hemosiderin
Smear Heinz bodies in RBC membrane

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26
Q

What metabolic abnormalities are associated with hypothyroidism?

A 
Hyperlipidemia
Hyponatremia
Elevated CK
Elevated LFTs
Normocytic, normochromic anemia
Thyrotoxicosis may cause hypercalcemia
27
Q

How do you manage hypothyroidism in pregnancy?

A

T4 requirements increase 30-50%
Increase in first, possibly second trimester, then repeat measurement in 2-4 weeks

Estrogen decreases TBG clearance, increasing TBG total, which decreases free T4 and increases TSH

28
Q

What are the two main diseases causing hypothyroidism, and what is the clinical sx of the thyroid gland?

A

Hashimoto - autoimmune - nontender thyroid

Subacute/lymphocytic - post-viral/post-partum - tender thyroid

29
Q

What are the screening recommendations for type 1 and type 2 diabetes?

A

Type 1 - fasting lipid panel

Type 2 - retinopathy, neuropathy, nephropathy, dyslipidemia

30
Q

DKA is associated with what electrolyte abnormality?

A

Hyperkalemia, 6-7mEq

with treatment (insulin), rapidly develop hypokalemia (4-4.5) due to depleted intracellular K in total body, effective tx should add K to IV fluids

31
Q

DKA is associated with what acid-base status?

A

High Anion gap metabolic acidosis

Increased H, decreased HCO3

32
Q

What are the screening recommendations for osteoporosis?

A

DEXA for women 65 or older, or younger women with risk factors

Risk factors: family history, low BMI, smoking history, steroid use, antiseizure meds

Treat if risk of fracture in 10 years is 20%, or 3% risk of hip fracture

In men or younger patients, screen for secondary cause (celiac, hypogonadism, malabsorption, hyperPTH, multiple myeloma)

33
Q

What is the definition of osteoporosis?

A

DEXA < -2.5 or presence of fragility fractures (compression fractures of vertebra, fracture of femoral neck, colles fracture of distal radius)

34
Q

What are the electrolyte imbalances associated with primary adrenal insufficiency?

A

Hyperkalemia
Hyponatremia

(loss of aldosterone)

35
Q

Waldenstrom macroglobulinemia

A

IgM spike

smear: rouleaux formation
biopsy: >10% clonal plasma cells

sx: hyperviscosity, neuropathy, bleeding, hepatosplenomegaly, lymphadenooopathy

36
Q

Multiple Myeloma

A

osteolytic lesions, anemia, hhypercalcemia, renal insufficiency

IgG, IgA, or light cahin spikes

smear: rouleaux
biopsy: >10% clonal plasma cells

37
Q

Hereditary spherocytosis

A

Sx hemolytic anemia, jaundice, splenomegaly

complication pigment gallstones, aplastic crises with b19

Lab high mean corpuscular hemoglobin, spherocytes on sphere
increased osmotic fragility
negative Coombs (positive in autoimmune hemolytic anemia)
abnl eosin-5-maleimide

tx folic acid, transfusion, splenectomy

38
Q

What are dietary, medical and surgical therapy options for kidney stones?

A

Diet: low protein diet, increase dietary calcium, low oxalate diet

If stone <5mm, fluids >2L/day for conservative management

Alpha blocker (tamsulosin)
Calcium channel blocker (nifedipine)
For stones less than 10mm with sx controlled

Extracorporeal shock wave lithotripsy is widely used, noninvasive, tx proximal ureter or intra-renal stones

39
Q

What are the guidelines for treating anemia in CKD?

A

Initiate EPO in CKD patients with hemoglobin <10

Target hemoglobin 10-11

40
Q

What are the screening guidelines for CKD?

A

In patients with T1D: yearly urine albumin-creatinine after 5 years of T1D
In patients with T2D: yearly urine albumin-Cr at time of diagnosis
In patients with FHx only: serum Cr, estimated GFR, UA

Diagnosis requires elevated Al-Cr ratio on 2 or 3 random samples over 6 months

41
Q

How do thiazide diuretics interact with calcium and uric acid?

A

(Recall: thiazides inhibit reabsorption of sodium (Na+) and chloride (Cl−) ions from the distal convoluted tubules in the kidneys )

Decrease uric acid excretion, causing hyperuricemia and may potentiate gout

Lower urinary calcium excretion, making them useful in preventing calcium-containing kidney stones

42
Q

Obesity hypoventilation yndrome

A

BMI>30, awake hypercapnia

Restrictive PFTs, chronic respiratory acidosis

Phys: alveolar hypoventilation

Tx with NPPV, weight loss

43
Q

What are the extrahepatic manifestations of chronic hepatitis C?

A

Essential mixed cryoglobulinemia

Membranoproliferative GN

Porphyria cutanea tarda or lichen planus

Increased risk of diabetes

44
Q

Neutropenic fever

A

ANC <1500
Usually pseudomonas or GNOs

Tx with antipsueodomonal beta-lactam: cefepime, meropenem, piperacillin-tazobactam (

45
Q

AIN

A

Caused by penicillin, TMP-SMX, cephalosporin, NSAIDs

maculopapular rash, fever, AKI
urinary eosinophils

46
Q

What is the treatment for syphilis? What about in a penicillin allergic patient?

A

Primary or secondary: Penicillin IM x1 or Doxycycline PO x 14 days
If latent: penicillin IMx3 or doxy x28 days
If tertiary: Penicillin IV x 14 days or ceftriaxone x 14 days

If penicillin allergic: if early syphilis, choose doxy. If CNS or pregnancy, go with penicillin desensitization.

47
Q

How do you manage hypercalcemia?

A

If symptomatic or calcium >14:

Short term: NS, avoid loop diuretics (volume depletion
Long term: bisphosphonate

If moderate or asymptomatic:
Avoid thiazide, lithium, volume depletion, and bed rest

48
Q

What do you treat Bell’s palsy with?

A

Prednisone PO

49
Q

How do you manage hypertension in ischemic stroke?

A

Maintain BP of less than 220/120

50
Q

When do you admit a TIA patient to the hospital?

A 
Age >60 =1
BP >140/90 =1
Hemiparesis=2
Duration 60min=2
Diabetes=1

If score is 3 or greater, admit to hospital

51
Q

What is conservative, nonmedical management for essential tremor?

A

Increase sleep, decrease caffeine

52
Q

When do you treat gout prophylactically?

A

> 2 attacks in 1 year = recurrent

Start colchicine (antiinflammatory) and allopurinol or febuxostat (urate-lowering)

53
Q

What is acanthosis nicgracans associated with?

A

Younger individuals, in groin/axilla/neck: insulin resistance or diabetes or PCOS

older individuals, in uncommon areas, or with weight loss: GI and GU cancer

54
Q

What is pyoderma gangrenosum associated with?

A

Inflammatory bowel disease

55
Q

What are the derm manifestations of Hep C?

A

Porphyria cutanea tarda

Curaneous leukocytoclastic vasculitis (palpable purpura) 2/2 cryoglobulinemia

56
Q

Dermatitis herpetiformis is associated with what?

A

Celiac disease

57
Q

What skin manifestations are asssociated with HIV?

A

Sudden onset severe psoriasis

Disseminated molluscum contagiosum

58
Q

Squamous cell carcinoma

A

Keratinized nodules with rough surface, thickened, ulcerated, crusting, bleeding.

Most common malignancy of lip

May have early perineural invasion leading to numbness and paesthesia

Biopsy shows keratin pearls

59
Q

Basal cell carcinoma

A

Pearly, flesh-pink nodule, with telangiectasia, on head or neck

May also have open sore that bleeds or crusts, central ulceration

60
Q

Pemphigus vulgaris

A

Flaccid bullae, mucosal erosions

Path: intraepidermal cleavage, acantholysis, intercellular IgG

61
Q

Bullous penphigoid

A

Pruritic bullae, tense

Path: subepidermal cleavage, IgG at basement membrane

62
Q

Sebhorrheic keratosis

A

“stuck on”
benign epidermal tumor; tan or brown, well-demarcated border

tx not usually required

63
Q

Seborrheic dermatitis

A

Fine, yellow, greasy-looking scales

Associated with Parkinsons and HIV

Topical ketoconazole/selenium sulfide

64
Q

Iron deficiency vs chronic disease iron labs

A

Iron deficiency: low iron, high TIBC, low ferritin, high RDW
Chronic disease: low iron, low TIBC, high ferritin, normal RDW

If mixed, will have low iron but may have normal TIBC/trasferrin and normal ferritin

Internal Medicine (4 decks)

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